‘Permanent Wall’ Keeps Kids From CHIP Program

Republicans in the Texas Legislature have created a “permanent wall” preventing thousands of Texas children from being able to obtain much-needed health insurance, regardless of how much money the state were to put into the program.

This revalation comes out of a press conference with State Rep. Garnet Coleman held Tuesday. While the Accenture contract (worth a whopping $899 million) and funding cuts are partially to blame for the problems with the CHIP program in Texas, the worst problems come from this “permanent wall.”

More restrictive requirements for the program including a new “asset test,” a more frequent enrollment process, an enrollment fee, elemination of some deductions, requirement of proof of income, a waiting period for enrollment and the application and renewal forms itself are the bricks and mortar that make up the wall keeping working Texas families from health insurance for their children, according to Coleman’s office.

The numbers on this speak for themselves. Before Accenture even laid a finger on the CHIP contract, more than 84,000 children had already lost CHIP coverage because of the policies that make up the “permanent wall.” Now, 200,000 fewer children are enrolled in the program than they were in September 2003 when the new regulations went in place:

Keep in mind, though, that Rick Perry and Texas Republicans don’t want the average Texan to know these figures. And, as easy as it is to blame the entire situation on Accenture, it’s the regulations that are the problem. And, it’s the regulations that go to the heart of the problem with the Republican Party and Perry in Texas and their attitude toward Texas’ middle class children:

“It’s campaign season, and they want to create an illusion that everything is okay,” Rep. Coleman said. “But numbers don’t lie. In the last year alone, the state has allowed almost $400 million in state funds appropriated for CHIP & Medicaid to go unspent. That extra money — which is now just sitting in the state’s bank account — would have easily covered every Texas child that lost CHIP coverage since May 2002.”

“The only reason Texas has more uninsured children than any other state in the country is because Governor Perry and the Republican leadership don’t consider our children’s health a priority.”

But, remember, even with the money, the “permanent wall” has made it such that the gap between the number of children who once were on CHIP and are now on CHIP is hard if not impossible to fill. And, it’s not because those kids don’t need the insurance any more either.

Consider this: A typical middle class family of four; mom and dad work minimum wage jobs or perhaps dad works a job that pays slightly higher. Dad has an old F-150 and mom has a car—they’re not brand new and not even recent models. But, even though the family falls within the 150% of the Federal Poverty Level income, they’re not able to cross the “permanent wall” because they bump up against the $5,000 liquid assets test that includes any bank accounts and vehicles. So, even working families are punished for their meger retirement savings and even saving money for college education for their children.

This is what Perry and the Republicans don’t grasp. They’re still stuck on the old mode of “welfare queen” driving to the post office in a Caddillac to pick up her welfare checks that Ronald Reagan and Speaker Tip O’Niell argued about.

Rick Perry has made some equally reprehensible statements in his imprudent attempts to defend the regulations that make up the “permanent wall:”

He doesn’t mince words when asked about matters such as Children’s Health Insurance Program rules that count assets such as autos in deciding eligibility.

“If someone thinks that their car is more important than their kids, we’re going to try to teach them a little personal responsibility here,” said Perry.

That’s not conservatism, compassionate conservatism or anything of the sort. It’s irresponsible and shows what little grasp people like Rick Perry have of the lives of the working poor. We want people to be able to get back and forth to work; the fact that they need a car to get back and forth to work to pay the rent, electric bill and water bill should not preclude their children from having health insurance they would otherwise be eligible for. This perhaps the most disgraceful, distasteful, out-of-touch, misguided, pathetic comment ever to come out of Rick Perry’s mouth. The very definition of personal responsibility for the working poor is that they would be able to have transportation to get to work, and that they take the initiative to get their children on health insurance.

These guidelines aren’t teaching personal responsibility by any stretch of the imagination. They’re penalizing the working poor, plain and simple.

Under the current “permanent wall” regulations, income requirements for the CHIP program are based on “gross” income calculation. Previously, they were based on “net” income calculation. With the gross income assessment, there is no allowance for income deductions such as child care which has automatically disqualified thousands of needy kids.

What’s all this doing? It’s putting parents in a position where they are penalized for working to get ahead.

Add this to an application so cumbersome some capitol insiders have likened it to a college application, stricter cost-sharing policies, and enrollment fees that families who need CHIP may not be able to afford.

Many people may not think these problems, like the problems with renewals and re-enrollment delays, are a big deal. If you believe that, perhaps you should ask young Devante Johnson, who had his cancer treatment put in jeopardy because of these very problems:

Devante’s insurance problems started while he was undergoing treatment for Stage 4 cancer at Texas Children’s Hospital earlier this year.

His mother, Tamika Scott, knew the Medicaid coverage for Devante and his two younger brothers was set to expire April 30. In Texas, families are required to renew their Medicaid and CHIP coverage every six months.

Scott submitted the paperwork two months before the April deadline, but officials say it sat unprocessed for six weeks because of a staffing shortage.

When someone finally looked at it, the worker determined Scott made too much money for Medicaid and instead qualified for CHIP, a program for the working poor. The application was forwarded to Texas Access Alliance, a private contractor that was put in charge of CHIP enrollment last year.

Scott said she tried tracking her application, but it was lost in the system. Repeated calls and multiple faxes got her nowhere. As the deadline passed, Scott realized her critically ill boy was without insurance coverage.

The saddest thing about all of this is that Republicans already had the opportunity to tear down the “permanent wall” and failed to do so. Keep in mind that Republicans like Martha Wong (and, of course, Rick Perry) are crowing about “restoring” CHIP funding and the like. But, the fact is they really didn’t do that or do all they could.

On April 6, 2005, Coleman offered Amendment 55 to CSSB 1, which would have taken $141 million from the Texas Enterprise Fund (Governor Perry’s slush fund) and put that money in the Children’s Health Insurance Program. In additionk last session, Coleman offered HB 3436 which would have eroded the permanent wall by reparing the failed policy changes that have built up the wall itself.

Even the Houston Chronicle has helped debunk this in a recent editorial:

Since eligibility screening was privatized by the state, more than 200,000 children in Texas have dropped off the rolls of Medicaid and the Children’s Health Insurance Program, 80,000 in the month of August alone. While politicians claim the drop results from an improving economy, Johnson’s story points to bureaucratic malfeasance as the culprit. His mother’s application sat unprocessed for more than a month because of staffing shortages, and then was forwarded to the Texas Access Alliance, the contractor hired by the state to screen applicants. It remained unprocessed until staffers for state Rep. Sylvester Turner, D-Houston, appealed to the Texas Health and Human Services Commission. The boy’s Medicaid coverage was finally reinstated, and he is receiving chemotherapy at M.D. Anderson and making progress.

The Permanent Wall has even attracted the attention of the Washinton Post:

Enrollment limits or freezes lasting six months or longer took effect in Alabama, Colorado, Florida, Maryland, Montana, North Carolina and Utah, Kenney said. Mississippi stopped accepting applications by mail. In Texas, where more than 20 percent of children are uninsured, the highest percentage in the nation, officials in 2003 imposed new premiums, eliminated dental coverage and began requiring families to re-enroll their children every six months rather than yearly.

Not long ago, State Rep. Coleman sent the TDH a letter asking some pointed questions about CHIP and children’s Medicaid enrollment. I found this answer particularly amusing:

The decline is also attributable to the non-disabled, on-TANF chidren’s risk groups (ages 1-18, expansion and federal mandate). Prior to October, 2005, these groups had stabilized after a three-year period of steady and sustained growth. Recent data have shown slight increases in this group; however, in September 2006 the caseload declined again. Some of the decline seen in this caseload over the past year is likely due to a stabilization after steady growth, and some is due to staffing shortages in eligibility field offices, which has been addressed.

It highlights another barrier to care for Texas kids. And, it responds to a simple question with a pile of gobeldy gook that actually sounds like it is trying to gloss over the real reasons for the decline. A paragraph before the one quoted above mentions a “consistent decline…largely due to non-renewal.”

As we’ve already learned with CHIP, the non-renewals are due mainly to the “permanent wall.”

So, what must the Legislature do to make sure that as many children as are eligible are able to get on CHIP? First, they need to tear down the “permanent wall.” Second, more funding is needed. However, money does no good until the wall is torn down.

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